External Nasal Valve Collapse Research Articles

Description of a Novel Technique to Address Both External Nasal Valve Collapse and the Aesthetic of the Nasal Tip.

Severe concavity of the lateral crura can lead to an unsightly aesthetic deformity of the nasal tip and narrowing of the external nasal valve. Concurrently, if the lateral crura are structurally weak, this can lead to a functional issue. We report a previously undescribed technique of combining a lateral crural reversal with a turn-in flap. This achieves dual goals of aesthetic improvement and structural reinforcement, without the need for grafting.

33959 Novel nasal alar reconstruction with hyaluronic acid after Mohs micrographic surgery and repair

Mohs micrographic surgery (MMS) has become a treatment of choice for certain nonmelanoma skin cancer, especially when lesions are located on aesthetically sensitive areas of the body such as the face. Due to the unique anatomy of the nose, reconstruction of nasal defects following MMS can present a challenge. Surgery to certain nasal structures, such as the ala, columella, or tip, can result in external nasal valve collapse. Reduction in the radius of the nasal valve areas by even a small amount can cause significant effect on nasal airflow and nasal resistance. Several methods may be employed for prevention or correction of nasal defects following MMS. For example, use of cartilage grafting has shown good results in maintaining nasal ala structure and reducing the risk of alar collapse. Furthermore, various suture techniques have been described that may be used intraoperatively to try to prevent alar collapse, including a 3-point suture and a suspension suture technique. In terms of postoperative correction, conservative measures are often used first. For instance, treatment of increased flap bulk causing compression may be done with steroid injection. If this should fail, flap debulking may become necessary to correct the issue. In cases of substantial external valve collapse, batten grafting has been used to repair the defect and improve inspiratory airflow. Here we present cosmetic filler as a novel method for treatment of nasal alar collapse in patients who may not wish to undergo surgical correction.

Functional Nasal Surgery.

After studying this article, the participant should be able to: (1) understand the functional significance of nasal anatomy as it relates to rhinoplasty and perform a comprehensive functional nasal assessment. (2) Identify the anatomical level of obstruction based on the authors' algorithmic approach and understand the current evidence supporting operative techniques for correcting nasal airway obstruction from septal deformity, inferior turbinate hypertrophy, internal nasal valve collapse, external nasal valve collapse. (3) Understand the current evidence supporting operative techniques for correcting nasal airway obstruction from septal deformity, inferior turbinate hypertrophy, internal nasal valve collapse, and external nasal valve collapse. (4) Appreciate the objective assessment tools for functional nasal surgery from a clinical and research perspective. The intent of functional rhinoplasty is to improve nasal airflow (and the perception thereof) by surgically correcting the anatomical sources of obstruction in the nasal airway. Cosmetic and functional rhinoplasty are not mutually exclusive entities, and the techniques that address one area, inevitably may affect the another. The rate of functional problems after cosmetic rhinoplasty range from 15 to 68 percent with nasal airway obstruction found to be the most common indication for secondary surgery. The objective of this CME article is to provide readers with an understanding of the (1) functional components of nasal anatomy, (2) clinical functional assessment, and (3) the current evidence supporting corrective maneuvers for each component.

Surgical Treatment of Dynamic Nasal Collapse.

Nasal obstruction is a prevalent issue that significantly impacts patient quality of life and contributes to a large-scale financial burden. Internal or external nasal valve collapse may play a role in nasal obstruction, with varying etiologies. Surgical correction of nasal valve collapse is indicated when septal and/or turbinate surgery alone are not sufficient in correcting the nasal obstruction. The choice of how to address nasal valve repair depends on presenting findings, associated aesthetic concerns, particularly of the nasal tip, patient anatomy, and surgeon preference. This article provides a methodical approach to the diagnosis of nasal valve collapse, indications for repair, and provides detailed explanation of the operative techniques used to address nasal valve collapse, while also discussing the advantages and disadvantages of each approach.

Nasal Tip Remodeling Using Autologous Cartilage Grafts: Systematic Review.

The objective of this study was to perform a systematic review of the literature to assess the clinical outcomes and safety profile of autologous cartilage grafts (A-CGs) in nasal tip remodeling (NTR). The protocol was developed following the Preferred Reporting for Items for Systematic Reviews and Meta-Analyses-Protocols guidelines. A multistep search of the PubMed, MEDLINE, Embase, Scopus database, and Cochrane databases has been performed to identify papers on A-CGs use in NTR. Of the 253 articles initially identified, only 39 articles providing either retrospective (n = 35) or prospective (n = 4) data about outcomes, descriptions, and complications of the A-CGs use in NTR were selected. Of these, 3 articles focused on alloplastic grafts were excluded. The nasal septum, concha, and ribs have been the main donor sites to build A-CGs to be used in NTR. Septal cartilage turned out to a specific and versatile, useful for many types of grafts tools, presenting a low rate of resorption, extrusion, and warping. Auricular concha cartilage has been used to correct both the internal and external nasal valve collapse, whereas rib chondral grafts have been used to improve the structural support when septal cartilage was not available. Crushed cartilage, minced cartilage, and diced cartilage have been used in noses with thinner soft tissues. Eighty percent of the analyzed studies focused on the description of the adopted surgical technique and A-CGs procedures of preparation, displaying encouraging aesthetic and functional outcomes with generally low levels of complications. Collected data confirmed the safety and efficacy of A-CGs-related interventions in NTR without major side effects.

Effect of alar rim graft on external nasal valve collapse and alar contour

Background: Alar rim collapse is an agonizing problem that has both cosmetic and functional sequalae. It has been usually addressed with batten grafts. In this study, we are describing a simple technique for insertion of alar rim grafts to fix external nasal valve collapse.Patients and Methods: Between January 2018 and October 2020, eighteen patients with alar rim collapse or deformities were addressed using alar rim septal cartilage grafting.Results: All patients who underwent alar rim grafting for external nasal valve collapse were evaluated functionally and aesthetically with post-operative follow up ranging from 12 to 24 month. During which, they showed marked improvement in their nasal airway patency with complete satisfaction for the aesthetic outcome. No complications were encountered.Conclusion: Alar rim grafting is a simple and effective approach to provide support for the external nasal valve and alar contour. In cases of malpositioned lower lateral cartilage, alar flaring, nasal tip deformities, mild retraction, or contour asymmetries, these cartilage grafts showed good outcomes in primary or revision cases.

Functional Outcomes, Quantitative Morphometry, and Aesthetic Analysis of Articulated Alar Rim Grafts in Septorhinoplasty.

The design, use, and indications for the articulated alar rim graft (AARG) and the functional and aesthetic improvements that can be achieved have not been fully characterized. To analyze the functional and aesthetic outcomes of AARG placement on nasal airway function, nasal base shape change, and appearance. A case series study of patients who underwent septorhinoplasty with placement of AARG at University of California, Irvine Medical Center, from 2015 to 2018 was carried out. Surgical data recorded included stage of rhinoplasty (primary vs revision), use of spreader grafts, rim grafts (and dimensions), caudal septal extension graft (CSEG), lateral crural tensioning (LCT), and turbinate reductions. Preoperative and postoperative Nasal Obstruction Symptom Evaluation Survey (NOSE) surveys were analyzed and correlated with AARG geometry, use of CSEG, and the LCT maneuver. Preoperative and postoperative alar base views were evaluated by fitting base shape to a parametric numerical model to categorize each to 1 of 6 shape categories. Blinded reviewers rated alar furrow severity and the alar ridge presence using a Likert scale for both preoperative and postoperative images to subjectively gauge aesthetic outcomes. Overall, 90 patients with both preoperative and postoperative NOSE scores who underwent septorhinoplasty and placement of an AARG were included. Of the 90 patients, 60 were women (mean age, 38.2 years). Patient NOSE scores (70.4 preoperatively to 25.1 postoperatively) significantly improved from preoperation to postoperation (P < .001), regardless of AARG size, CSEG, or LCT. Alar base shape parametric analysis showed preoperative to postoperative improvements were significant for anterior-to-posterior ratio mass distribution (95% CI, -0.16 to 0.02; P = .05) and vertical projection-to-horizontal base width ratio (95% CI, 0.01-0.32; P = .02) in flat noses and cloverleafing for narrow noses (95% CI, -0.05 to -0.01; P = .001); enhancement approached significance for reduction in lateral scalloping in cloverleaf noses (P = .06). Aesthetic analysis showed that there was a statistically significant improvement for the alar furrow (95% CI, -0.68 to -0.29 for rater 1; -0.54 to -0.27 for rater 2; and -0.59 to -0.27 for rater 3; P < .001) for all raters and for the alar ridge (95% CI, 0.16-0.48; P < .001) for 1 rater. To our knowledge, this is the first study to demonstrate that AARG use is associated with statistically significant improvement in NOSE scores. Placement of AARGs may improve posterior mass ratios in flat noses and lateral cloverleafing in narrow noses as suggested by quantitative shape change parameter analysis. The placement of AARGs was associated with aesthetic and functional enhancement in the cloverleaf deformity, which is associated with a prominent alar furrow, and often external nasal valve collapse. Patient selection is key when placing AARGs. NA.

Literature scans: cartilage grafts in nasal tip rhinoplasty

In the last years, surgical strategies in rhinoplasty were deeply modified with a gradual shifting from a reductive rhinoplasty, with aggressive intervention and trimming of the cartilages, to a more conservative and then “additive” rhinoplasty. We aimed to report the different types of autologous cartilage graft and the specific indications for each one. The authors reviewed 201 papers published in the last 10 years in the international literature database PUBMED and EMBASE deciding to isolate only those articles providing either retrospective or prospective data pertaining to outcomes, descriptions, and complications of the cartilage grafts use in nasal tip’s rhinoplasty. Of the 201 articles, 96 were initially selected. Of these, 38 met the predetermined criteria for inclusion. Nasal septum, concha, and the ribs are the main sources for autografts to be used in rhinoplasty. Septal cartilage is easy to harvest, it is versatile, could be useful for many types of grafts, and it has a low percentage of resorption, extrusion, and warping. Cartilage from the auricular concha can be used to correct both the internal and external nasal valve collapse with satisfactory results. Costal chondral grafts are usually used for structural support when septal cartilage is not available. It is possible to divide autologous grafts into two main categories: structural grafts (columellar strut, septal extension, and the alar batten grafts) and contour improving grafts (onlay tip, shield, cap, and the alar rim grafts) useful for the structural support to the tip and smoothing and hiding irregularities. Level of Evidence: Not ratable.

The impact of surgical manipulation on lower lateral cartilage stiffness

Cephalic trimming of the alar (or lower lateral) cartilage may cause weakening leading to external nasal valve collapse. Numerous methods have been proposed to combat this weakening in order to maintain lateral crural stiffness. The purpose of this study was to quantify the effect of mucosal stripping, cephalic trimming, cephalic turn-in flap, and lateral crural strut grafting on lateral crural stiffness. In situ cyclic compressive loading was performed on eight lateral crura in 4 fresh frozen cadaveric specimens. Testing was performed on the unaltered degloved cartilage (intact) and following each of the following interventions: mucosal stripping, cephalic turn-in flap, cephalic trimming, and lateral crural strut grafting. Linear regression of the generated force-displacement curves was used to calculate stiffness. Each intervention was compared to the intact cartilage. Alar cartilage of all of the specimens demonstrated a linear response to compressive loading. Intact cartilage had a mean stiffness of 3.53 N/mm. Mucosal stripping and cephalic turn-in flaps yielded similar stiffness values to intact cartilage. Cephalic trimming reduced stiffness in all cases by a mean of 1.09 N/mm (p = 0.003). Lateral crural strut grafting significantly increased stiffness by a mean of 3.67 N/mm (p = 0.0001). Cephalic trimming leads to decreased lateral crural stiffness in cadaveric specimens. Cephalic turn-in flaps restore pre-trimmed stiffness, and lateral crural strut grafting increases overall stiffness of the cartilage. These findings should be considered in patients undergoing rhinoplasty, particularly if there are concerns regarding potential external valve collapse.

External Nasal Valve Repair in Children: Alar Batten Graft Reinforced by External Temporary Suspensory Suture.

The nasal valve area is the narrowest point in the nasal airway. External nasal valve (ENV) collapse during inspiration occurs if external valve area is too narrow or its lateral component is too floppy. Twelve patients (7 males, 5 females) aged 8 to 12 years complaining of nasal obstruction due to ENV dysfunction underwent surgical intervention using alar batten graft assisted by temporary external suspensory suture. All patients showed subjective and objective improvement of the nasal airway. The mean Nasal Obstructive Symptom Evaluation (NOSE) was 14 ± 1.71 before surgery and 7.83 ± 1.47 1 year after surgery (significant improvement, p ≤ .0001). The mean Peak Inspiratory Flow Rate was 29.92 ± 4.46 before surgery and 42.58 ± 4.93 1 year after surgery (significant improvement, P ≤ .0001). External nasal valve collapse in children can be managed surgically by using alar batten graft. Temporary suspension suture can be helpful for supporting of the graft until complete healing occurs.

Reliability and construct validity of the Ottawa valve collapse scale when assessing external nasal valve collapse

BackgroundNasal valve collapse is a common cause of nasal obstruction in otolaryngology practice. Common examination methods, such as the Cottle Maneuver and modified Cottle Maneuver are available. However, these methods are dichotomous and do not provide ordinal severity information. The Ottawa Valve Collapse Scale (OVCS) is a grading system for assessing and easily grading external nasal valve collapse in patients with a septal deviation. The primary objective was to assess the test-retest reliability and construct validity of the OVCS grading scale. A secondary objective was to perform the same assessments on the Cottle Maneuver.MethodsPatients with a septal deviation who were requesting surgical correction were prospectively enrolled in the study. All patients were assessed using both the Cottle Maneuver and the OVCS by one otolaryngologist at two visits separated by one month. The phi coefficient was calculated to assess the test-retest reliability of the instruments. Results of the Nasal Obstruction Symptom Evaluation (NOSE) Score was compared to determine construct validity.ResultsNinety-two patients met our inclusion criteria. The phi coefficient was 0.62 for the OVCS and 0.32 for the Cottle Maneuver. The scores on the NOSE instrument were positively associated with the OVCS scores (p = 0.01) while there was no association with the Cottle Maneuver (p = 047).ConclusionThis current preliminary analysis suggests that the novel Ottawa Valve Collapse Scale has good test-retest reliability and construct validity. This scale may help clinicians grade external nasal valve collapse in patients with a septal deviation. Future studies are required to determine if this scale assists surgeons in determining which patients need formal nasal valve surgery in addition to a standard septoplasty.

A combined use of Chondrocytes Micro Grafts (CMG) Mixed with Platelet Rich Plasma (PRP) in Patients Affected by Pinch Nose Deformity

Background: The combined use of autologous chondrocytes micro-grafts (CMG) mixed with Platelet Rich Plasma (PRP) is an alternative that opens a new era in this field. Materials and Methods: At the Department of Plastic and Reconstructive Surgery, University of Rome “Tor Vergata”, Italy, 15 patients, affected by pinch nose deformity underwent nasal alar reconstruction with chondrocytes micro-grafts gentle poured onto PRP in solid form. A CT scan control was performed after 12 months. Pearson’s Chi-square test was used to investigate difference in cartilage density (CD) between native and newly formed cartilage. Results: The constructs of CMG-PRP subcutaneously injected resulted in cartilage tissue with adequate central nutritional perfusion. Postoperative follow-up evaluation has shown optimal aesthetic results and improvement of nasal obstruction. These composite grafts provide functional support to the alar cartilages, usually collapsed in pinch nose deformity because of excessive resection during previous surgery. Conclusion: This report demonstrated that chondrocytes micrografts derived from nasal septum poured onto PRP in solid form are a useful method for cartilage regeneration in patients affected by external nasal valve collapse.

Association of Lateral Crural Overlay Technique With Strength of the Lower Lateral Cartilages.

The lateral crural overlay technique is a powerful technique for altering nasal tip projection and rotation. By overlapping and thus shortening the lateral crura, the nasal tip is shortened and rotated upward, thus decreasing projection and increasing rotation. There is no data to show the association of this technique with the strength of the lower lateral cartilage. Strengthening of the lower lateral cartilages would presumably lead to resistance to external nasal valve collapse and improved airway. In this cadaver study, we set out to determine the differences in the strength and resilience of the lateral crura after performing lateral crural overlay using 2 different techniques. Seven individual lower lateral cartilages were harvested from 6 cadavers for analysis. Each of the 7 cartilages was included sequentially in 3 test groups in the following order: a preprocedure group (preP), a postprocedure group (postP) in which the lateral crural overlay technique was performed, and a postprocedure with glue group (postPG) in which cyanoacrylate glue was added to the postP cartilages to simulate cartilage healing. A force gauge was used to measure the force required to deflect the lower lateral cartilages distances from 1 to 6 mm. Differences measured in newtons (N) for strength and resilience of lateral crura between the preP, postP, and postPG groups. A statistically significant increase in lower lateral cartilage resilience was noted between the preP and postPG groups at all distances of tip deflection (1 mm, 0.20 vs 0.70 N; P < .001; 2 mm, 0.26 vs 1.13 N; P < .001; 3 mm, 0.31 vs 1.53 N; P < .001; 4 mm, 0.41 vs 2.05 N; P < .001; 5 mm, 0.68 vs 2.60 N; P < .001; 6 mm, 1.49 vs 3.26 N; P = .03). There was a statistically significant difference between the postP and postPG groups in the amount of force required to deflect the cartilages 1 to 5 mm (1 mm, 0.24 vs 0.70 N; P < .001; 2 mm, 0.34 vs 1.13 N; P < .001; 3 mm, 0.51 vs 1.53 N; P < .001; 4 mm, 0.77 vs 2.05 N; P < .001; 5 mm, 1.32 vs 2.60 N; P = .01), but not 6 mm (2.33 vs 3.26 N; P = .31). The lateral crural overlay technique affords increased strength and resilience to the lateral crura of the lower lateral cartilages, which should in turn decrease the likelihood of external nasal valve collapse postoperatively. NA.

Surgical Correction of Alar Collapse with Alar Batten Graft : Technique and Results

Background: nasal valve collapse has great perception of nasal obstruction. The alar batten graft technique has proven to be a valid method for treatment of external and internal valve collapse. Aim: the aim of the present study was to evaluate a two year experience and follow up for external nasal valve collapse treatment using alar batten graft technique regarding results and complications. Patients and Methods: this prospective study was carried out on 18 patients attended the ENT and Plastic Surgery outpatient clinics of Al-Azhar University hospitals from January, 2014 to January 2016. Written consent was taken from every patient. All patients were complaining of nasal obstruction of gradual onset and progressive course with 7 years average. All patients were subjected to detailed history taking and questionnaire including the NOSE scale. Surgical correction was performed to all patients using the alar batten graft harvested from the septa cartilage or conchal cartilage. Postoperative results recorded in relation to subjective sensation of nasal obstruction and aesthetic appearance of the nose. Results: eleven patients (61.1%) were males and seven (38.9%) were females. Their age ranged from 18 to 45 years with a mean of 32±2. Bilateral obstruction was found in 33.3% of cases and unilateral obstruction in 66.7% of cases. There were 22.2%, 27.8%, and 50.0% of the cases had moderate, fair, and severe obstruction, respectively. Postoperatively, these figures were changed to no obstruction77.8% (P=0.0), mild 0.0%, moderate 11.1%, fair 11.1%, and sever 0.0%(P=0.0005). The technique significantly abolishes the severe nasal obstruction. Postoperative complications include 1 case with graft resorption (4.2%) and 1 case of graft displacement (4.2%). Both were improved on subsequent surgery. Regarding postoperative findings there was tenderness and hypertrophic postauricular scar in 5.5% of patient and nasal tip edema in 22.2%, all resolved. In the early postoperative period, 33.3% of patients complained of fullness in the supraalar region. Conclusion: Successful surgical correction of nasal obstruction requires the precise diagnosis of the anatomic point of collapse. Alar batten graft improves the rigidity of lower lateral cartilage preventing collapse of the lateral nasal wall preventing collapse during moderate and deep inspiration. The graft varies according to the severity of the obstruction and size of the collapsible area of the lateral nasal wall. The septal cartilage is usually sufficient. The technique significantly improves nasal breathing.

Reliability of a Standardized Nasal Anatomic Worksheet and Correlation With Subjective Nasal Airway Obstruction.

Nasal obstruction is a common chief concern; however, a comprehensive standardized worksheet for evaluating nasal obstruction has not been developed. To evaluate the interrater reliability between staff surgeons and otolaryngology residents using a worksheet-based standardized nasal examination and to identify specific examination findings correlated with the Nasal Obstruction Symptom Evaluation quality-of-life score. This cross-sectional study conducted from June to July 2012 involved 50 adults presenting to an otolaryngology clinic at a tertiary care hospital. The patients were examined by 2 board-certified facial plastic surgeons and 2 otolaryngology residents. The inferior turbinates, septum, and internal and external nasal valve narrowing and collapse were graded bilaterally from a scale of 0 to 3 with the aid of a standardized nasal anatomy worksheet. The findings were compared between the attending staff, residents, and the entire group. The Cohen κ coefficient for interrater reliability was calculated for each of the graded metrics. The Nasal Obstruction Symptom Evaluation scores were correlated with anatomic scores. Of the 49 patients included in the final analysis, the mean age was 43.6 years (range, 21-82 years), and 31 were male (66.3%). Among all attending and resident examiners, a moderate to fair, statistically significant interrater reliability coefficient (P < .001) was observed in the following nasal anatomic measurements: left and right Cottle (κ = 0.582 [95% CI, 0.463-0.700] and κ = 0.580 [95% CI, 0.461-0.698], respectively), modified Cottle (κ = 0.491 [95% CI, 0.373-0.609] and κ = 0.560 [95% CI, 0.442-0.679], respectively), dynamic internal nasal valve collapse (κ = 0.204 [95% CI, 0.118-0.290] and κ = 0.232 [95% CI, 0.140-0.323], respectively), and inferior turbinate hypertrophy (κ = 0.252 [95% CI, 0.152-0.352] and κ = 0.235 [95% CI, 0.153-0.317], respectively). The trend of examination interrater reliability was similar for attending staff and the otolaryngology residents. The Nasal Obstruction Symptom Evaluation score correlated with the mean total anatomic worksheet score (Spearman ρ = 0.301; P = .048). Interrater reliability is high in both residents and attending staff for dynamic nasal airway examinations evaluating the internal and external nasal valves and for turbinate hypertrophy assessment. The total nasal anatomic score using a standardized worksheet correlates to patient-reported nasal-specific quality of life. NA.

Reconstruction of Alar Nasal Cartilage Defects Using a Tissue Engineering Technique Based on a Combined Use of Autologous Chondrocyte Micrografts and Platelet-rich Plasma: Preliminary Clinical and Instrumental Evaluation.

Background:Developing cartilage constructs with injectability, appropriate matrix composition, and persistent cartilaginous phenotype remains an enduring challenge in cartilage repair. The combined use of autologous chondrocyte micrografts and platelet-rich plasma (PRP) is an alternative that opens a new era in this field.Methods:At the Department of Plastic and Reconstructive Surgery, University of Rome Tor Vergata, Italy, 11 patients underwent nasal alar reconstruction with chondrocyte micrografts gently poured onto PRP in solid form. A computed tomographic scan control was performed after 12 months. Pearson’s Chi-square test was used to investigate difference in cartilage density between native and newly formed cartilages.Results:The constructs of chondrocyte micrografts–PRP that were subcutaneously injected resulted in a persistent cartilage tissue with appropriate morphology, adequate central nutritional perfusion without central necrosis or ossification, and further augmented nasal dorsum without obvious contraction and deformation.Conclusion:This report demonstrated that chondrocyte micrografts derived from nasal septum poured onto PRP in solid form are useful for cartilage regeneration in patients with external nasal valve collapse.

Diagnosis and Treatment of Dynamic External Nasal Valve Collapse: Application of Alar Batten Graft and Alar Flaring Suture

Diagnosis and Treatment of Dynamic External Nasal Valve Collapse: Application of Alar Batten Graft and Alar Flaring Suture

Evaluation of Improvement in Nasal Obstruction Following Nasal Valve Correction in Patients With a History of Failed Septoplasty.

Patients with a septal deviation and concerns about nasal obstruction often undergo septoplasty to improve nasal airflow. Following primary septoplasty, however, some patients have persistent symptoms due to nasal valve dysfunction and may require nasal valve surgery. To evaluate the change in disease-specific quality of life for patients who undergo nasal valve correction after failed septoplasty using the Nasal Obstruction Symptom Evaluation (NOSE) survey and to determine whether identifiable anatomical risk factors are more common in patients with a history of failed septoplasty. Prospective observational outcomes study conducted at a tertiary care medical center. Forty patients who underwent nasal valve correction through an open approach from January 1, 2012, through December 31, 2014, with a history of septoplasty for nasal obstruction were included. Data analysis was conducted from January 1, 2013, through May 1, 2015. [corrected]. Demographic information, a standardized nasal examination, and preoperative and postoperative NOSE scores were collected and reviewed. Comparison between preoperative and postoperative NOSE scores at 2, 4, and more than 6 months after surgery. Forty patients were included in the study; 23 (57%) were male and 17 (43%) were female. The mean age was 39.3 years. Findings from preoperative nasal examination demonstrated moderate or severe internal nasal valve narrowing in 38 (95%) patients, internal nasal valve collapse in 19 (48%), external nasal valve narrowing in 18 (45%), or external nasal valve collapse in 16 (40%). The most common anatomical cause of obstruction was internal nasal valve narrowing in 38 (95%) patients, dorsal septum deflection in 26 (65%), and narrowed middle vault in 16 (40%). The mean (SD) preoperative NOSE score was 75.7 (20.1). Mean (SD) postoperative NOSE scores at 2, 4, and greater than 6 months were 31.4 (27.2), 34.0 (19.8), and 22.1 (18.8), respectively, with significantly improved NOSE scores at each time point compared with before surgery (P < .001). Nasal valve dysfunction remains an underdiagnosed entity and should be considered in all patients with septal deviation before septoplasty, especially in patients with a severe dorsal deflection and a narrow middle vault. In this study, surgical nasal valve correction demonstrated a significant reduction in nasal obstruction, as measured by a validated outcome measure, in patients for whom a previous septoplasty had failed. 4.

A modified V-Y chondromucosal composite flap for correction of secondary cleft nasal deformity: photogrammetric analysis of a case-control study.

Secondary cleft nasal deformity is a combination of the inherent cleft defects and the effects of operations to address the primary nasal deformity. The authors revisited a modified V-Y chondromucosal flap to restore symmetric nostril shape and balanced tip projection. A retrospective case-control study of the senior author's (J.A.T.) experience with secondary cleft tip rhinoplasty using the V-Y chondromucosal flap was conducted. Preoperative and postoperative anteroposterior and worm's-eye photographs were compared by means of photogrammetric analysis. Results were compared with those of controls who had not undergone surgery. Interrater reliability was assessed using the Pearson coefficient. Seventeen cases and 24 controls were reviewed. Average age at repair was 9.3±3.6 years; average follow-up was 13 months. Interrater reliability was 0.98 overall. Photogrammetric analysis demonstrated postoperative increases in cleft-side columella length by 2.3 mm (p=0.0001) and nasal apex height by 1.3 mm (p=0.003); non-cleft-side measurements were statistically unchanged. Control measurements were similar across 1-year visit interval, and when compared with cases, patients undergoing tip rhinoplasty had significantly different cleft-side columella length postoperatively (increase of 2.31 mm versus 0.15 mm; p=0.0002) and nasal apex height (increase of 1.29 mm versus 0.17 mm; p=0.03). All other parameters remained comparable. No complications and no external nasal valve collapse were observed. In select patients, use of a V-Y chondromucosal flap increased cleft-side nasal tip projection and columellar height, improving overall nasal tip appearance. Although absolute width of the cleft alar base is unchanged, the cleft-side nostril is qualitatively more symmetric postoperatively. Therapeutic, III.

External nasal valve collapse: validation of novel outcome measurement tool

We aim to validate a clinical scoring system of external nasal valve collapse. External nasal valve collapse is a rare and challenging condition. We attempted to simplify the examination of the external valve, the surgical planning and the outcome measure. To validate our external valve score, we first assessed its reliability (inter-rater agreement and test-retest repeatability). We secondly considered the clinical relevance by using our scoring system in patients undergoing septorhinoplasty for external valve collapse. For validation, 16 Rhinologists scored patients separately on two occasions. For the clinical relevance, 26 patients with external valve collapse were scored pre- and post-operatively (responsiveness). The external valve score was correlated to peak nasal inspiratory flow. The devised scoring system was reliable (substantial agreement between 16 surgeons with reproducibility over time). All patients in our prospective series showed significant improvement in their external valve score. The quality of life measured by the SNOT-22 tool showed significant improvement after surgery. External nasal valve collapse can be diagnosed and graded using this simple scoring system in the outpatient clinic. This paper reinforces the pivotal role of septorhinoplasty surgery in nasal airway reconstruction and the ongoing need to quantify success.